Asthma symptoms usually occur for the first time in children, but the condition may appear at any age. When asthma symptoms begin in older adults, such as during the 60s or 70s, the symptoms are often confused with other lung conditions more frequently present in the elderly. Older age complicates not only the diagnosis but also the treatment of asthma, as older adults often suffer from other chronic health conditions and regularly take several types of medication.
Asthma
Asthma is a chronic condition affecting the airways, explains Marianne Frieri, M.D., of the American Academy of Allergy Asthma and Immunology. Allergies, infections or other triggers cause inflammation and obstruction of the airways. In older adults, allergies are less important as a trigger than for children. Unlike childhood asthma, which may go into remission, asthma in older adults remains active and severe, notes the Asthma and Allergy Foundation of America. After 20 years of age, women are more likely to develop asthma than men. Fluctuating hormones may play a role, as women are more likely to develop asthma before or after a pregnancy or after menopause. Prolonged exposure to household irritants, such as molds, cigarette smoke, perfumes or dust, may cause asthma symptoms to appear suddenly in an older adult.
Symptoms
Wheezing, coughing and chest tightness are common asthma symptoms, says Frieri. In the elderly, these symptoms are often incorrectly attributed to age, smoking or congestive heart failure. Symptoms of asthma in the elderly may appear in forms different from those seen in younger people with asthma. For example, coughing may occur only at night. Shortness of breath after exercise and a chest cold that lingers longer than 10 days may also be signs of asthma in the elderly, suggests the Asthma and Allergy Foundation.
Diagnosis
Underlying medical conditions complicate asthma diagnosis in the elderly, Frieri states. Sinusitis, gastroesophageal reflux disease, heart conditions or other lung conditions such as chronic bronchitis or chronic obstructive pulmonary disease make asthma diagnosis difficult. Diagnosis depends on a detailed history, including all environmental irritants, and tests of lung function.
Treatment
Asthma treatment typically includes a bronchodilator to expand obstructed air passages and a corticosteroid to reduce airway inflammation. Elderly patients with asthma, however, may not respond to the standard medications, notes Frieri. Older adults do not respond as well as younger adults or children to inhaled medications, and corticosteroids can accelerate symptoms of osteoporosis. Arthritis reduces dexterity and makes it difficult for the elderly to manipulate inhalers. Older adults are likely taking other medications, so drug interactions must be considered. They also may be unable to follow instructions because of cognitive impairments, such as Alzheimer's disease.
Considerations
Asthma is a more serious condition in the elderly than in children and is more likely to lead to respiratory failure, according to the Asthma and Allergy Foundation. A mild attack for an elderly person is the equivalent of a severe attack in a child. Medications for chronic underlying conditions may aggravate asthma symptoms, and some asthma medications may increase heart rate and should be used with caution in the elderly.
